Your Questions
Your Questions
Q: Dr. Eppley, I see that you have a post on various implants that can be implanted in the body. My left thigh (inner part) is more curved and less developed than my right thigh. I have attached some pictures of my inner thighs. I’m wondering if you perform implants of this kind. Can you please let me know? I cannot find any surgeons in the U.S. who perform this kind of implant. Thank you.
A: I did get your pictures and can see the inner thigh difference in contour to which you refer. The question is whether an implant is the appropriate solution to that problem. I ask that question for two reasons. First there will be a noticeable scar in the inner thigh through the implant must be placed. While it is not a long scar (3 -4 cms), the inner thigh is a sensitive area in terms of less than ideal scarring. Secondly, the location of the implant would be between the sartorius and the vastus medialis muscles which is a good submuscular location. (although this is a superficial inner thigh muscle) Since there is no true thigh implant, the best body implant choice would be a calf implant which is long and slender and would seem to have an appropriate shape for this location and the overlying muscle. Current calf implant lengths are 15 cms (small) to 24 cms long.(large) It would be helpful for you to outline on your leg your perceived length of the contour area and what is lengths in cms. is.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 35 year-old male born with a significant facial asymmetry. I have a prominent left sided zygomatic prominence, a left ptosis and a slightly recessed left sided forehead. I also have prominent inverted-U shaped supra-orbital bossing, which divides my forehead into two, and cast unaesthetic shadows especially when I stand under light. I do understand that there are limitations to what could be corrected but I will like to explore what can be corrected. My surgical objectives would be; 1) repair of left ptosis, 2) reduction/shaving of the zygomatic prominence, 3) zygoma fossa augmentation and 4)
forehead contouring with burring/infracture of supra-orbital bossing +/- forehead augmentation. I have attached images for your review. I have also used a plastic surgery simulator to put my desire in a picture form. I would appreciate your review and consult.
A: I have taken a careful look at your pictures, including the simulations, as well as your goals and can make the following comments.
- The width of the zygomatic body/arch can be narrowed by an anterior and posterior osteotomies. (infracture method)
- The prominent brow bones could be reduced by osteotomy/infracture method. (brow bone reduction)
- #1 and #2 could be done through a coronal incisional approach. Since #2 mandates that this be used, #1 would take advantage of that approach also.
- You are showing a high temporal augmentation in the superior temporal zone. I believe you are incorrectly calling this area the zygoma fossa which I think you mean temporal fossa. This area could be augmented through the same incisional approach as #1 and #2. This would require an onlay augmentation using PMMA given the quantity of material needed as well as the size of the surface area.
- To optimally smooth out the forehead above the brow bones, some augmentation would need to be done as well above the brow bone infractured area.
- Your left upper eyelid ptosis appears to be in the 1mm to 2mm range which could be treated by an internal Mueller’s muscle resection.
- I also noticed that you have performed rhinoplasty for narrowing of your nose and lower lip reduction as well.
As you can see in the above description, the key to most of your desired changes is the need for a scalp or coronal incision to do them.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My upper lip is big and hangs over my teeth. i am looking for a lip lift. I am in my mid 50s Am I good candidate for it. Will my upper lip look bigger or the same.
A: An upper lip lift, presumably through a subnasal incision location, would produce only a minimal amount of lip lift as it relates to improving tooth exposure. It would make the central part of the upper lip look bigger. If you are happy with the current size of your upper lip, a subnasal lip lift would not be the appropriate procedure. If you do not mind more vermilion upper lip enlargement, then it would be a reasonable procedure to do. But it may take a concurrent lip tuck-up done from the inside the lip as well to get the desired amount of improved tooth show.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I underwent mandible angle and cheekbone reduction surgery over a year ago. I am disappointed with the changes as it has feminized my previously masculine face. I find that the angle reduction from my jaw is unnaturally high and much too straight to be considered normal. What options could I consider to replace the previous bony structure? Another issue that I am faced with is substantial mid to low face sagging. Several areas seem to be affected such as the infra-orbital muscle (clearly visible, elevated on cheekbone), nasolabial folds, and soft tissue isolation (sides of mouth, fat cheek look). Could you explain the causes of these irregularities and possible procedures that I could undertake?
A: I have seen a few cases just like yours where the jaw angles have been completely amputated. The angular shape and the vertical height of the ramus of the mandible can be restored by jaw implant augmentation. But the implant shape can not be a standard jaw angle implant. it needs to be shaped to just have a vertical augmentation only that has an oblique superior shape to match the oblique cut. That can be done by either using one of the custom jaw angle implant shapes that I have previously used or have one made off of a 3D CT scan.
As for the other facial changes those are obviously a result of the cheekbone reduction. I am going to assume that this procedure was done intramurally with n obliquely oriented osteotomy of the zygomatic body and a posterior osteotomy of the zygomatic arch. That has caused loss of support of the surrounding cheek tissues which not sag creating an orbicular is muscle edge show, deepening of the nasolabial folds and sagging in the submalar area. Like the jaw angle issue, adding back some skeletal support would seem like a logical approach. That effectiveness, however, is not as clear as it would be in the jaw angle area.
Dr. Barry Eppley
Indianapolis, Indiana